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Medication-overuse headache: Bridging therapies for detoxification.

Benjamin R Wakerley1, Prut Koonalintip2

  • 1Department of Neurology, University Hospital Birmingham, United Kingdom; Metabolic Neurology, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, The Medical School, The University of Birmingham, United Kingdom.

Clinical Neurology and Neurosurgery
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PubMed
Summary

Medication-overuse headache (MOH) treatment involves withdrawing the overused acute medication, which significantly reduces headache days. Bridging therapies help manage withdrawal symptoms for successful detoxification.

Keywords:
Bridging therapiesChronic migraineMedication-overuse headacheRebound headache

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Area of Science:

  • Neurology
  • Pharmacology

Background:

  • Medication-overuse headache (MOH), or rebound headache, complicates chronic migraine due to frequent acute pain medication use.
  • The underlying causes of MOH involve a complex interplay of psychosocial factors, medication class, and genetic predispositions in pain pathways.

Purpose of the Study:

  • To review the medication withdrawal process for different acute medication classes in MOH.
  • To examine various pharmacological and non-pharmacological bridging therapies used to support MOH detoxification.

Main Methods:

  • This narrative review synthesizes existing literature on MOH treatment strategies.
  • Focuses on medication withdrawal protocols and adjunctive therapies.

Main Results:

  • Acute medication withdrawal is the primary treatment for MOH, leading to reduced monthly headache days at 8 weeks.
  • Withdrawal can exacerbate headaches and cause psychological/physical symptoms, necessitating supportive therapies.

Conclusions:

  • Successful MOH management relies on effective medication withdrawal and supportive bridging therapies.
  • Further research into optimizing bridging strategies for different medication classes is warranted.